Preliminary study on predictors of early death risk in patients with exertional heat stroke
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摘要: 目的 通过对劳力性热射病患者入院24 h检查结果进行统计学分析，寻找快速鉴别短期预后的指标。方法 将我院2016年1月1日至2022年12月31日收治的81例热射病患者，按28 d预后结果分为存活组(58例)和死亡组(23例)。对2组间基础资料、检验结果、衍生比值进行比较，并进行多因素Cox回归分析、Kaplan-Meier生存曲线、受试者工作特征曲线分析，从而寻找判断短期预后的相关指标。结果 2组间各项指标比较发现，29个指标差异有统计学意义(P＜0.05)。多因素Cox回归分析提示，谷草转氨酶/谷丙转氨酶比值(P=0.02)和血小板分布宽度(P=0.04)是影响热射病患者预后的独立危险因素。Kaplan-Meier生存曲线发现，谷草转氨酶/谷丙转氨酶比值与患者的生存状况具有显著相关性(P < 0.001)，而血小板分布宽度与患者的生存状况无相关性(P>0.05)。受试者工作特征曲线分析显示，谷草转氨酶/谷丙转氨酶比值预测劳力性热射病患者预后的曲线下面积为0.738。结论 谷草转氨酶/谷丙转氨酶比值可作为预测劳力性热射病早期死亡风险的指标，用于指导急诊科医生分层治疗。
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关键词:
- 劳力性热射病 /
- 短期预后 /
- 谷草转氨酶/谷丙转氨酶 /
- 预测指标 /
- 分层治疗
Abstract: Objective To explore indicators for rapid identification of short-term prognosis of patients with exertive heat stroke by conducting statistical analysis on the 24-hour examination results of patients with occupational heat stroke upon admission.Methods A total of 81 patients with heat stroke who admitted to our hospital from January 1, 2016 to December 31, 2022 were divided into survival group(58 cases) and death group(23 cases) according to 28-day prognosis. The basic data, test results and derived ratio were compared between the two groups. Multivariate Cox regression analysis, Kaplan-Meier survival curve and receiver operating characteristic curve analysis were used to find out the related indicators to predict the short-term prognosis.Results The comparison of various indicators between the two groups showed that there was a statistically significant difference in 29 indicators(P < 0.05). Multivariate Cox regression analysis showed that the ratio of aspartate aminotransferase to alanine aminotransferase(P=0.02) and platelet distribution width(P=0.04) were independent risk factors affecting the prognosis of patients with heat stroke. Kaplan-Meier survival curve showed that the ratio of aspartate aminotransferase to alanine aminotransferase was correlated with the survival condition of patients(P < 0.001), while the platelet distribution width was not correlated with the survival condition of patients(P>0.05). The receiver operating characteristic curve analysis showed that the area under the curve of the ratio of aspartate aminotransferase to alanine aminotransferase for predicting the prognosis of patients with exertional heat stroke was 0.738.Conclusion The ratio of aspartate aminotransferase to alanine aminotransferase can be used as an index to predict the risk of early death in exertional heat stroke, which can be used to guide emergency physicians to stratified treatment. -
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表 1 2组间基线资料、生命体征、血气分析结果比较
指标 存活组(58例) 死亡组(23例) t/F P 男/例(%) 39(67.24) 21(91.30) 5.66 0.02 年龄/岁 23.00(21.00，26.75) 32.00(23.00，40.00) 3.84 ＜0.01 平均动脉压/mmHg△ 85.67(78.83，88.83) 81.67(62.33，88.50) -1.54 0.14 体温/℃ 37.64±1.26 38.50±1.70 2.49 0.02 呼吸/(次/min) 23.09±7.22 26.04±9.25 1.53 0.13 心率/(次/min) 93.31±22.43 125.13±29.21 5.27 ＜0.01 氧分压/mmHg 133.02±36.29 92.57±32.92 -4.60 ＜0.01 二氧化碳分压/mmHg 29.68±7.76 30.35±7.52 0.35 0.72 二氧化碳含量/(mmol/L) 22.12±4.13 21.99±5.68 -0.11 0.91 pH值 7.37(7.17，7.63) 7.33(6.23，7.62) -1.98 0.06 △1 mmHg=0.133 kPa。 
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表 2 2组间血生化指标和衍生比值结果比较
指标 存活组(58例) 死亡组(23例) t/F P 血常规指标 白细胞计数/(×109/L) 7.82(3.00，20.90) 11.50(4.41，28.78) 2.68 0.13 NEU/(×109/L) 5.32(0.75，17.48) 8.36(2.04，23.89) 3.04 0.01 淋巴细胞计数/(×109/L) 1.79(0.43，4.12) 0.84(0.19，9.18) -0.18 0.86 红细胞计数/(×1012/L) 5.01(3.91，5.89) 4.95(3.12，5.60) -2.01 0.54 RDW/% 41.05(36.60，50.00) 41.50(37.20，53.20) 2.23 0.03 血红蛋白/(g/L) 148.50(111.00，179.00) 145.00(87.00，191.00) 4.63 0.05 红细胞压积/% 0.43(0.34，0.50) 0.41(0.29，0.55) -1.04 0.31 PLT/(×109/L) 208.44±60.17 118.04±84.18 -5.42 ＜0.01 PDW/% 12.89±2.55 14.72±4.57 2.30 0.02 炎症指标 IL-6/(ng/mL) 5.23(3.78，7.45) 46.30(32.61，106.25) 2.31 0.01 PCT/(ng/mL) 0.05(0.02，0.87) 3.20(0.07，100.00) 2.58 0.02 凝血指标 PT/s 11.40(9.70，19.30) 14.10(7.20，120.00) 3.21 ＜0.01 APTT/s 26.70(18.30，40.20) 29.50(17.00，119.40) 2.66 0.01 INR 0.99(0.85，1.83) 1.34(0.89，6.24) 4.15 ＜0.01 D-D/(μg/mL) 0.25(0.03，58.00) 3.24(0.41，47.74) 2.43 0.02 心功能指标 Lac/(mmol/L) 2.75±3.19 5.03±4.18 2.64 0.01 B型钠尿肽/(pg/mL) 25.45(15.18，44.41) 812.00(63.82，2 812.00) 1.96 0.06 肌酸激酶同工酶/(IU/L) 3.40(1.43，8.05) 48.20(5.10，100.40) 1.18 0.25 肌钙蛋白/(IU/L) 0.02±0.05 16.41±68.10 1.15 0.26 MB/(IU/L) 53.38(28.10，97.50) 748.00(172.10，3 514.00) 4.25 ＜0.01 LDH/(IU/L) 206.00(184.00，234.50) 503.00(331.00，1 331.00) 2.37 0.03 肝功能指标 总胆红素/(μmol/L) 14.05(3.78，53.80) 19.00(7.60，161.60) 2.65 0.14 DBIL/(μmol/L) 6.55(1.70，11.70) 8.40(1.50，111.60) 4.34 ＜0.01 ALB/(g/L) 45.40±4.70 39.21±10.37 -2.75 0.01 球蛋白/(g/L) 28.91±4.39 27.05±6.40 -1.29 0.21 AST/(IU/L) 24.50(9.00，91.00) 123.00(12.00，6 658.00) 4.09 ＜0.01 ALT/(IU/L) 19.00(6.00，192.00) 45.00(7.00，6 552.00) 3.62 ＜0.01 ALB/球蛋白 1.61±0.31 1.53±0.42 -0.84 0.46 肾功能指标 Cr/(μmol/L) 96.00(61.00，169.00) 170.00(62.00，494.00) 3.96 ＜0.01 BUN/(mmol/L) 5.30±1.88 8.84±5.84 4.14 ＜0.01 尿酸/(μmol/L) 407.19±127.81 492.39±190.31 1.98 0.06 衍生比值 血红蛋白/RDW 3.58±0.51 3.29±0.70 -1.82 0.08 RDW/ALB 0.91±0.11 1.18±0.36 5.17 ＜0.01 RDW/PLT 0.20(0.12，1.61) 0.46(0.12，11.05) 2.79 0.01 D-D/PLT 1.30×10-3(9.60×10-5，0.24) 0.05(1.20×10-3，2.42) 3.62 ＜0.01 D-D/ALB 6.00×10-3(5.80×10-4，1.19) 0.07(9.60×10-3，1.57) 3.65 ＜0.01 D-D/B型钠尿肽 9.30×10-3(8.30×10-4，4.52) 7.30×10-3(2.80×10-4，0.81) -0.62 0.53 D-D/肌钙蛋白 28.25(1.39，11 600.00) 12.58(4.20×10-3，285.00) -1.13 0.26 PT/INR 12.11±2.54 12.25±5.09 0.13 0.90 AST/ALT 1.26±0.63 1.86±0.94 2.81 0.01
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表 3 AST/ALT、PDW预测劳力性热射病患者短期预后的ROC曲线分析
项目 AST/ALT PDW 曲线下面积 0.738 0.620 最佳截断值 1.36 15.40% 灵敏度/% 73.91 34.78 特异度/% 75.86 87.93 95%CI 0.61~0.87 0.48~0.77
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